1. Recommendations for MBP prior to elective surgery
- MBP is not recommended for adult or pediatric patients having colorectal procedures including open or laparoscopic total or segmental colonic resections, Hartmann procedure, abdominoperineal resection (APR), total proctocolectomy (TPC), ileal pouch anal anastomosis (IPAA). The only exception is patients having anterior resection with an anastomosis at or below the sacral promontory (Level of evidence: High)
- MBP is not recommended for patients undergoing urologic surgery (including prostate, kidney and bladder surgery) unless the colon will be used to construct a conduit or to augment the bladder. (Level of evidence: Moderate)
- MBP is not recommended for patients having benign gynecological procedures (Level of evidence: Low)
- There is insufficient evidence to provide a recommendation for gynecological procedures for cancer
- Patients having an open or laparoscopic anterior resection defined as a rectal resection where the anastomosis is at or below the sacral promontory should have a MBP prior to surgery (Level of evidence: Moderate)
2. Recommendations for Fleet Enema prior to elective surgery
- A Fleet Enema should not be prescribed prior to surgery (Level of evidence: Low)
3. Recommendations for oral antibiotics prior to surgery
- If a patient does have a MBP, oral antibiotics should be given. In most instances, this will be only patients who are having an anterior resection (Level of evidence: High)
- Metronidazole 500 mg and neomycin 500 mg should be prescribed and taken at 1 PM, 3 PM and 8 PM on the day before surgery. MBP should start at 3 PM. (Level of evidence: expert consensus)